Combined esophageal intraluminal impedance, pH and skin conductance monitoring to detect discomfort in GERD infants

BACKGROUND: The clinical significance of weakly acidic reflux in infants is unclear. Skin conductance is a novel not-invasive method to evaluate discomfort. The aim of our study was to evaluate reflux-induced discomfort in infants with gastroesophageal reflux disease using simultaneously combined skin conductance and esophageal multichannel intraluminal impedance and pH monitoring. METHODOLOGY/PRINCIPAL FINDINGS: Infants with gastroesophageal reflux symptoms were investigated for almost 20 hours divided into 120-second intervals. Temporal relationships between refluxes and discomfort were evaluated calculating the symptom association probability. Twelve infants aged 17-45 days were studied. Out of 194.38 hours of adequate artifact-free MII/pH and skin conductance monitoring, 584 reflux events were observed; 35.78% were positive for stress, of which 16.27% were acid and 83.73% weakly acidic. A significant association between refluxes and discomfort (p<0.05) was present in all infants. The intervals with reflux events showed increased skin conductance values compared to reflux-free intervals (p<0.001); SC values were similar for acid and weakly acidic reflux events. CONCLUSION/SIGNFICANCE: Discomfort was significantly associated with reflux events and did not differ between weakly acidic and acid refluxes. Our results may raise concerns about the over-prescription use of antacid drugs in the management of gastroesophageal reflux symptoms in infancy

Sviluppare la competenza etica degli studenti con gli strumenti della didattica a distanza: studio qualitativo su un forum di discussione sulla maternità surrogata

Introduction: The University had to quickly adapt to the social distancing rules put in place to contain the spread of the COVID-19 pandemic in the last year. The e-learning tools, already made available by the University of Turin, have been implemented to avoid the interruption of training and “distance learning” has become the prevailing teaching method.As a comparison tool, an online forum was proposed to the nursing students to elaborate reflections on surrogacy for commercial purposes in India and on a series of related ethical dilemmas; then all comments were analyzed and the contribution made by the discussion to the development of ethical competence in future professionals was evaluated. Methods: Students were shown the documentary "Google Baby". An exploratory question was posted on the online forum dedicated to students to start a careful analysis and elaborate a comment on the topic. All contributions, collected anonymously, were subjected to a qualitative analysis by three reviewers. Results: The collected comments were 50. The sample consisted of 7 men (15%) and 43 women (85%) aged between 21 and 41. From the analysis of all the writings, the most frequently discussed themes were identified. Discussion: The need to replace "traditional" teaching with distance learning has required a considerable commitment from the teachers, especially in seeking a teaching method capable of accompanying and motivating students in the process of learning and personal and professional growth. The results showed the effectiveness: in the comments the students focused on different aspects and ethical principles, fundamental to address the dilemmas that arise in daily nursing and at the basis of professional behavior.Introduzione: L’Università si è dovuta rapidamente adattare alle norme di distanziamento sociale disposte per contenere la diffusione della pandemia da COVID-19 nell’ultimo anno. Gli strumenti di e-learning, già resi disponibili dall’Università degli Studi di Torino, sono stati implementati per scongiurare l’interruzione della formazione e la Didattica a Distanza (DAD) è diventata la modalità d’insegnamento prevalente. Agli studenti del corso di Laurea in Infermieristica è stato proposto, come strumento di confronto, un forum online per elaborare delle riflessioni sulla maternità surrogata a scopo commerciale in India e su una serie di dilemmi etici che derivano; successivamente è stata fatta un’analisi di tutti i commenti ed è stato valutato il contributo dato dalla discussione allo sviluppo della competenza etica nei futuri professionisti. Materiali e metodi: E’ stataproposta agli studenti la visione del documentario “GoogleBaby”. Su un forum online dedicato, è stata pubblicata una domanda esplorativa peravviareun’attenta analisi ed elaborare un commento sul tema. Tutti i contributi, raccolti in forma anonima, sono stati oggetto diun’analisi qualitativa da parte di tre revisori. Risultati: Sono stati raccolti in totale 50 elaborati di altrettanti studenti, di cui 43 donne (85%), d’età compresa tra 21 e 41 anni. Dall’analisi qualitativa di tutti gli scritti, sono stati individuate 4 unità naturali di significato: opportunità per committenti e surrogate; modalità d’implementazione; dignità, libertà e integrità; contesti geografici diversi dall’India. Discussione: La necessità di sostituire la didattica “tradizionale” con la DAD ha richiesto un notevole impegno da parte dei docenti, soprattutto nel cercare una modalità di insegnamento in grado di accompagnare e motivare gli studenti nel processo di apprendimento e di crescita, personale e professionale. I risultati ne hanno evidenziato l’efficacia: nei commenti gli studenti si sono soffermati su diversi aspetti e i principi etici, fondamentali per affrontare i dilemmi che si pongono nell'assistenza infermieristica quotidiana e alla base del comportamento professionale

Severe hyponatremia due to water intoxication in a child with sickle cell disease: A case report

Water intoxication is a potentially fatal hypo-osmolar syndrome with brain function impairment. Isolated symptomatic excessive ingestion of free water is very rare in childhood. We report a case of acute hyponatremia due to water intoxication without Antidiuretic Hormone (ADH) excess in a child with sickle cell disease. The boy was admitted to our Emergency Department because of new-onset prolonged generalized seizures. Blood test showed hyponatremia, and elevated creatine kinase value; neuroimaging was negative. His recent medical history revealed that on the day before he had drunk about 4 liters of water in 2 hours to prevent sickling, because of back pain. He was treated with mild i.v. hydration with normal saline solution and showed progressive clinical improvement and normalization of laboratory test. Rhabdomyolysis is a rare complication of hyponatremia whose underlying mechanism is still unclear

Frequency and type of domestic injuries among children during COVID-19 lockdown: what changes from the past? An Italian multicentre cohort study

: Accidents are the main cause of injury in children, more than half events happen at home. Aims of this study were to assess if SARS-CoV-2 lockdown influence emergency department (ED) visits due to children domestic accident (DAs) and to identify factors associated with hospitalization. This was a multicentre, observational, and retrospective cohort study involving 16 EDs in Italy and enrolling children (3-13&nbsp;years) receiving a visit in ED during March-June 2019 and March-June 2020. Risk factors for hospitalization were identified by logistic regression models. In total, 8860 ED visits due to domestic accidents in children occurred before (4380) and during (4480) lockdown, with a mean incidence of DA of 5.6% in 2019 and 17.9% in 2020 (p &lt; 0.001) (IRR: 3.16; p &lt; 0.001). The risk of hospitalization was influenced by the type of occurred accident, with fourfold higher for poisoning and twofold lower risk for stab-wound ones. In addition, a higher risk was reported for lockdown period vs 2019 (OR: 1.9; p &lt; 0.001), males (OR: 1.4; p &lt; 0.001), and it increased with age (OR: 1.1; p &lt; 0.001).&nbsp; &nbsp; Conclusions: The main limitation of this study is the retrospective collection of data, available only for patients who presented at the hospital. This does highlight possible differences in the total number of incidents that truly occurred. In any case, the COVID-19 lockdown had a high impact on the frequency of DAs and on hospitalization. A public health campaign aimed at caregivers would be necessary to minimize possible risks at home. What is Known: • In Italy, domestic accidents are the second leading cause of paediatric mortality after cancer. • During the first SARS-CoV-2 lockdown in 2020, a sharp decrease in the total number of Emergency Departments visits for all causes was observed, both in children and in adults. What is New: • During the first SARS-CoV-2 lockdown in 2020, domestic accidents involving children increased threefold from the previous year. • Higher risk of hospitalization was showed in minors accessing during 2020 vs 2019, in males than in females and&nbsp;it increased with advancing age. Considering the type of injury, a significant higher risk of hospitalization for poisoning was observed

Pediatric admissions to emergency departments of North-Western Italy during COVID-19 pandemic: A retrospective observational study

COVID-19 pandemic caused huge decrease of pediatric admissions to Emergency Department (ED), arising concerns about possible delays in diagnosis and treatment of severe disorders

Oral ondansetron versus domperidone for acute gastroenteritis in pediatric emergency departments: Multicenter double blind randomized controlled trial

The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1-6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20-0.83) and domperidone (RR 0.47, 98.6% CI 0.23-0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1-6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis